Why So Glum?: A History of Depression and Its Treatments

Depression has been around since Homo erectus began taking out mortgages on caves while negotiating with saber-toothed tigers about who would pick up dinner. Until fairly recently, however, treatment for the condition was rudimentary at best.

MODERN PROBLEMS

Each year 17 million Americans are diagnosed with depression. According to a recent poll, one in six Americans say they’ve struggled with depression at some time during their lives. That’s an awful lot of melancholy. Better diagnosis’ and an easing of social stigmas means more people than ever are seeking help; but it’s not all sunshine for current and future sufferers. According to studies, only around ten percent of patients receive adequate treatment. Modern therapies include everything from acupuncture and analysis to herbs and aromatherapy, as well as supplements and, most recently, antidepressants. Even though they’re not always effective, today’s remedies are usually far better than the treatments that came before.

MISUNDERSTOOD MELANCHOLIA

In the 5th century BCE, Hippocrates, the father of Western Medicine, described depression (which he deemed melancholia) as a condition “in which sadness, anxiety, moral dejection, tendency to suicide, aversion to food, despondency, sleeplessness, irritability and listlessness is accompanied by prolonged fear.” It’s pretty much the same definition that ended up in American psychiatric manuals in the 1950s. Even though Hippocrates was right on with his description of the disease, he was a little off on the cause, which he attributed it to a buildup of black bile in the spleen.

I NEED THAT LIKE I NEED ANOTHER HOLE IN MY HEAD

Although ancient physicians correctly identified the source of depression as “somewhere in the head,” it wasn’t good news for the afflicted. Sufferers, who were believed to be possessed by supernatural demons, were often subjected to a technique known as trephining. A special tool was used to drill or scrape a hole into the person’s skull to release the evil spirits. It was the go-to remedy for not only mental illnesses like depression but also chronic headaches, head injuries and, most likely, the common cold. At one archeological site in France dating to 6500 BCE in which120 skulls were discovered, a full one third had been trephined. A few of the patients even survived the procedure: some for years afterward!

TAKE TWO SHACKLES AND DON’T BOTHER CALLING ME IN THE MORNING

Hippocrates wasn’t alone in his misdiagnosis of depression. Down through history, the diagnoses and, thus, the treatments for depression have varied wildly. During the Dark Ages, the condition was believed to be a sign of God’s disfavor and its victims were labeled heretics or witches. One popular cure at the time included the imprisonment of the “sacrilegious” sufferers. However, shackling patients in a dank cell wasn’t very effective, with many of the caged patients reporting, “You’ve never experienced depression until you’ve spent time in a medieval dungeon.” Probably. A more effective treatment for the condition during the Dark Ages was execution, which sported an unbeatable 100% success rate. Apparently, in the Middle Ages, killing someone before he killed himself was considered preventative medicine.

COME ON BABY, ENLIGHTEN MY FIRE

It wasn’t until the enlightenment that depression began to be recognized as the clinical condition it is, paving the way for more humane treatments. (Of course any treatment was more humane than either imprisonment or death.) One popular attempt at a cure – “the bath of surprise” – involved submerging a patient in scalding-hot or freezing-cold water to “shock their minds back into a normal state.” In the early 1700s, Dutch physician Dr. Hermann Boerhaave invented the “gyrating chair” to achieve a similar effect. The chair, which spun at up to 100 rotations per minute, could be “employed in the dark, where, from unusual noises, smells, or other powerful agents, acting forcibly on the senses, its efficacy might be amazingly increased.” Unfortunately, its sum effectiveness involved knocking some patients unconscious while causing others to “bleed from the mouth, ears and nose.” Of course, it became very popular in both Europe and the United States. In the 1780s, French physician Philippe Pinel committed to reforming care for the mentally ill after a close friend – who he described as having “nervous melancholy” – killed himself. Pinel eventually took over the Bicêtre insane asylum and forbade the shackling of depressed patients in dungeons. Instead, Pinel provided them with sunny rooms and encouraged exercise. Many of Pinel’s patients got better.

SOMETIMES A CIGAR IS JUST A CIGAR

In 1795, German doctor Johann Reil first coined the term “psychiatry.” Reil used “psychic” treatments such as massage, opium and flogging, in addition to the popular bath of surprise (to which he added his own special twist: cannon fire!) to “restore patients to their senses.” Reil also came up with something called “The Hollow Wheel.” The wheel was a completely enclosed, human-sized wooden hamster wheel in which sufferers were imprisoned for between 36-48 hours, during which time they could “either remain stationary or run forward or backward.” At least Reil was making an attempt. In many places – including the US – clinically depressed people were often just tossed into asylums with other mentally ill patients. Left to suffer in overcrowded conditions, its no surprise that almost none of them got better. It wasn’t until the early 20th century that “talking cures” pioneered by Sigmund Freud, Carl Jung and others began to catch on. Today, talk therapies, along with cognitive behavioral therapy, are important tools in the fight against depression.

PIECE OF MIND

By the mid 1930s, state hospitals in the US were overflowing with nearly half a million patients and there began a desperate push to return the mentally ill to society. In 1938, a Portuguese doctor named Antonia Egas Moniz noticed that certain psychoses, including paranoia and obsessive-compulsive disorder, involved recurrent thought patterns. Moniz believed he could interrupt these patterns by surgically separating the nerve fibers connecting the frontal and prefrontal cortex to the thalamus deep in the brain. He later expanded his procedure to include mood disorders such as depression. In the operation, which he called “white matter cutting” (but which later became known as a frontal lobotomy), two incisions were made on either side of the brain into which ice picks were inserted and then swept back and forth through the brain tissue. The most exuberant advocate of the lobotomy, however, was an American doctor by the name of Walter Freeman. Freeman, who eventually co-founded and served as president of the American Board of Psychiatry and Neurology, performed over 3,500 lobotomies himself, despite admitting that he was “uninterested in understanding what was happening in the brain.” Freeman even figured out a way to dispense with special equipment – he simply jammed a surgical scalpel up under the eyelid to accomplish the job in under ten minutes. Surprisingly, some depressed patients actually seemed to get better. Most weren’t helped at all and others, including John F. Kennedy’s sister, Rosemary, got much worse. In 1949, Moniz was awarded a Nobel Prize for his work in the field of psychosurgery. The “successful” lobotomies turned out to be a fluke, however, as it was discovered that the new calmness some patients experienced was due to the fact that their personalities had been completely erased by the procedure. Thankfully, lobotomies went out of fashion in 1954 when drug therapies began to appear. Moniz, for his part, was shot in the back by a former patient and spent the rest of his life as a paraplegic. Freeman has gone down as perhaps the second most reviled physician of the 20th century behind the infamous Nazi doctor, Josef Mengele.

I’LL TAKE THE BATH OF SURPRISE INSTEAD

A person being treated for depression in the 1930s and 40s would have been marginally luckier to receive the other popular therapy at the time: electroshock. The good news about electroshock therapy is that it actually helped many people with more serious forms of depression including bipolar disorder. (Today, electroshock has garnered the tamer moniker; electroconvulsive therapy, or ECT.) The bad news was, at least in its early days; ECT was only slightly less cruel than having a doctor cram a scalpel through a patient’s eye socket. Early adopters – especially those in mental institutions – often used electroshock as a way to control, intimidate and punish inmates in a procedure known as “measuring.” Many patients received hundreds of sessions. Broken bones were common as convulsing patients flailed about. Today, anesthetics and muscle relaxers are used to avoid that particular nasty side effect. ECT, while still considered a last resort treatment, has come a long way and, today, is one of the success stories in the fight against major depression.

THIS IS YOUR MOOD ON DRUGS

Although certain chemicals had been used in the treatment depression since the late 19th century, it wasn’t until the 1950s that drugs were employed to treat the patient’s symptoms rather than to simply sedate her. In 1949, an Australian psychiatrist named J.F.J. Cade introduced a powerful psychotropic drug, Lithium, in the quest to overcome a variety of mental illnesses including depression. Thorazine came next in 1952. It was quickly followed by imipramine; the first tricyclic antidepressant. Other tetracyclic antidepressants, such as mianserin and maprotiline, were developed in the 1970s. In 1987, fluoxetine became the first selective serotonin reuptake inhibitor (SSRI) approved by the US Food and Drug Administration (FDA). Better known by its brand name, Prozac, it remains one of the most widely prescribed drugs ever devised. In the 1990s, second generation SSRIs were introduced under brand names such as Paxil, Celexa and Zoloft.

HAPPY NOW?

Although psychotropic drugs, talk therapies and even ECT have helped countless millions of sufferers, today many researchers are rethinking their entire approach to depression. Their prescription? The same one Philippe Pinel came up with in the 18th century: exercise and sunshine. Believe me, both beat a poke in the eye with a sharp scalpel any day.

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Michael Kerr is an award-winning freelance writer living in Portland, Oregon. His work has appeared in numerous publications both online and off, including Portland Business Journal, Healthline Networks, Eat Drink Better, USA Today and many others. He blogs about nutrition and fitness for Hive Health Media and other websites.